A multicenter evaluation of variables affecting the predictability of creatinine clearance.

Data from 722 urine collections (627 patients) from 14 medical facilities were used to compare measured creatinine clearance values with clearance estimates calculated using three "urine-free' mathematical formulas. The influence of two patient weight variables (actual weight, lean body weight) and the level of renal function on clearance prediction was assessed. In addition, site parameters (region, facility), time parameters (month, day, day of the week), and patient parameters (age, sex, height, weight, diagnoses) were evaluated for their statistical influence on the relationship between measured clearance and estimates calculated with one of the methods. Strong, statistically significant correlations were observed between clearance values estimated with each prediction method and measured clearances. Although statistical differences were noticed between mean values predicted with each method, these differences were clinically insignificant. Use of lean body weight for calculation of creatinine excretion produced clearance estimates that were significantly lower than those obtained with actual weight and substantially closer to measured clearance values. Among patient variables, age and two specific diagnoses (congestive heart failure and pregnancy), were statistically associated with variability in the relationship between measured and predicted clearance. Interregional and interfacility differences in the measured-predicted clearance relationship, variability associated with the day of the week of collection, and tendency of the urine-free formulas to over-predict clearance support potential inaccuracy of measured clearance determination. The results suggest that inaccuracies in clearance determination, rather than inadequacies of urine-free prediction methods, account for the majority of the observed variability in the relationship.

The North Carolina Area Health Education Center program: an overview.

North Carolina has been at the forefront of the planning, development, and operation of area health education centers (AHECs). These centers have dramatically improved health manpower education and training at all professional levels. In effect, the North Carolina Area Health Education Center Program is a major decentralization and coordination of medical, dental, pharmacy, and public health education and regionalization of nursing, allied health education, medical residency training, and continuing education. The program links each of the university health science centers in North Carolina to major community hospitals that form a regional network with other institutions. The University of North Carolina at Chapel Hill School of Pharmacy has a major role in the AHEC program. A full-time faculty is located in each AHEC. In addition to providing and coordinating clinically oriented pharmaceutical services and functioning as a resource in all matters relating to drugs, they are extensions of the school's faculty. The North Carolina AHEC Program approach offers pharmacy an excellent opportunity to maximize the pharmacist's contributions to society through education and practice.